Comparison of Long-term Outcomes in Patients with Premature Triple-vessel Coronary Disease Undergoing Three Different Treatment Strategies： A Prospective Cohort Study

Background： Patients with premature triple-vessel disease （PTVD） have a higher risk of recurrent coronary events and repeat revascularization： however, the long-term outcome of coronary artery bypass grafting （CABG）, percutaneous coronary intervention （PCI）, and medical therapy （MT） alone for PTVD patients is controversial. The aim of this study is to evaluate the long-term outcome of PTVD patients among these three treatment strategies, to find out the most appropriate treatment methods lbr these patients. Methods： One thousand seven hundred and ninety-two patients with PTVD （age： men 〈50 years and women _〈60 years） were enrolled between 2004 and 2011. The primary end point was all-cause death. The secondary end points were cardiac death, myocardial infarction, stroke, or repeat revascularization. Results： PCI, CABG, and MT alone were performed in 933 （52.1%）, 459 （25.6%）, and 400 （22.3%） patients. Both PCI and CABG were associated with lower all-cause death （4.6% vs. 4.1% vs. 15.5%, respectively, P 〈 0.01） and cardiac death （2.8% vs. 2.0% vs. 9.8%, respectively, P 〈 0.01 ） versus MT alone. The rate of repeat revascularization in the CABG group was significantly lower than those in the PCI and MT groups. After adjusting for baseline factors, PCI and CABG were still associated with similar lower risk of all-cause death and cardiac death versus MT alone （all-cause death： hazard ratio [HR]： 0.35, 95% confidence interval [CI]： 0.23-0.53, P 〈 0.01 and HR： 0.35, 95% CI： 0.18-0.70, P= 0.003, respectively, and cardiac death： HR： 0.32, 95% CI： 0.19-0.54, P〈 0.01 and HR： 0.36, 95% CI：0.14-0.93, P = 0.03, respectively）. Conclusions： PCI and CABG provided equal long-term benefits for all-cause death and cardiac death for PTVD patients. Patients undergoing MT alone had the worst long-term clinical outcomes.

Pathogenesis of premature coronary artery disease:Focus on risk factors and genetic variants

The development of premature coronary artery disease(PCAD)is dependent on both genetic predisposition and traditional risk factors.Strategies for unraveling the genetic basis of PCAD have evolved with the advent of modern technologies.Genome-wide association studies(GWASs)have identified a considerable number of common genetic variants that are associated with PCAD.Most of these genetic variants are attributable to lipid and blood pressure-related single-nucleotide polymorphisms(SNPs).The genetic variants that predispose individuals to developing PCAD may depend on race and ethnicity.Some characteristic genetic variants have been identified in Chinese populations.Although translating this genetic knowledge into clinical applications is still challenging,these genetic variants can be used for CAD phenotype identification,genetic prediction and therapy.In this article we will provide a comprehensive review of genetic variants detected by GWASs that are predicted to contribute to the development of PCAD.We will highlight recent findings regarding CAD-related genetic variants in Chinese populations and discuss the potential clinical utility of genetic variants for preventing and managing PCAD.